Forbes

April 19, 2012

At a time when half of primary care doctors say they'd leave medicine if they had an alternative and the NY Times reports on a family physician who can't give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there's one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to get out. Conversely, when the conventional wisdom is to avoid something, that's often the time savvy investors jump in.

For my money, if I could invest in family medicine residency programs right now, I would. As primary care leaders such as Dr. Glen Stream, President of the American Academy of Family Physicians, wrestle with a reimbursement system that has disadvantaged primary care, they should be emboldened that there is an increasing conclusion that the only way to improve the health of the population and reduce healthcare costs is to to build it on a primary care foundation.

The following reasons are why I believe primary care is due for a renaissance:

1. Retainer-based direct primary care is exploding around the country providing an alternative for primary care physicians to the insurance bureaucracy laden model most practice in. It's one area of strong bipartisan support in the healthcare debate. The "Marcus Welby/Steve Jobs Solutions to the Medicaid-driven State Budget Crisis&ldquo is just one example of how a properly developed primary care model could change the face of medicine in this country. They've proven a model that is affordable and effective while providing primary care physicians with a much improved professional experience. 
   
   
2. Some of the most successful entrepreneurs and venture capitalists of the last 20 years are investing in primary care based practices. Benchmark Capital is one of the most well regarded venture capitalists with investments in organizations such as eBay and Twitter. They have been a major backer of One Medical Group which has had great success with their primary care model. The founders of aQuantive, Amazon, Dell and Expedia have backed Qliance, one of the pioneers of the direct primary care model. These investors know about disrupting the status quo. Whereas traditional practices have been slow to adopt technology, these organizations are using technology as a point of differentiation.
   
   
3. Simple laws of supply and demand. There's already a shortage of primary care. Look to Massachusetts to see the further demands expanding coverage has put on primary care.  While one can argue the merits of that health reform, it's indisputable that it has created more demands on primary care. Analysts believe a core reason CIGNA and Humana have bought onsite clinic businesses is to ensure they have a supply of primary care physicians as demand increases for primary care.
   
   
4. The rise of onsite clinics that have primary care as their foundation continues to create more demand for primary care doctors. Dissatisfaction by purchasers of healthcare will continue to expand the onsite clinic trend.
    
5. In the so-called "Pharma 3.0" trend, pharmaceutical companies are repositioning themselves as "health outcomes" companies. Major players I've spoken with are putting primary care as central focus areas which is a shift from where many of them have focused. In one case, they are already delivering primary care themselves.
   
   
6. As the Chief Technology Officer of the U.S. outlined in this video on market opportunities in healthcare innovation, the reimbursement model is radically shifting. With Patient Centered Medical Home (PCMH) pilots consistently showing positive return on investment, the PCMH pilots coming out of the federal reform set up a major shift in reimbursement as outlined in the video segment. If they show, as they have virtually everywhere else, that there's a positive ROI, Medicare reimbursement can shift without any congressional action. With Medicare reimbursement driving overall reimbursement, the impact of that would be massive.
   
   
7. Studies such as IBM's global study on the $2B they spend annually on healthcare have produced a consistent conclusion. That is, the formula is quite simple. The countries with the highest proportion of primary care have the healthiest populations and spend lower per capita on healthcare. Every government and business is budget constrained and these findings will be hard to ignore. IBM's Dr. Paul Grundy has been a leader along with executives at other large corporations such as Johnson & Johnson, GSK and others in an organization called the Patient-centered Primary Care Collaborative (PCPCC). Behind the scenes, the PCPCC has encouraged more focus on primary care in health reform and elsewhere.

The knee-jerk reaction to the predicted renaissance of primary care is to believe it will come at the expense of specialists. As I commented in an earlier piece on Direct Primary Care, that potential zero-sum-game is the elephant in the room, but the biggest fat in the system is burdening day-to-day healthcare with insurance bureaucracy. Physicians would be well advised to address that rather than fight amongst themselves in my opinion.

No renaissance comes without some bumps in the road, but I'd argue that the next twenty years of primary care will be far better than the last twenty.

Dave Chase is CEO of Avado.com, a Patient Portal & Relationship Management software company, previously founded Microsoft's Health business and was a consultant with Accenture's Healthcare Practice.  He can be found on Twitter @chasedave.